舟山市儿童超重肥胖和下丘脑-垂体-肾上腺轴与抑郁症状的关联及交互作用分析

Association and interaction analysis of overweight/obesity and hypothalamic-pituitary-adrenal axis-related with depressive symptoms in children in Zhoushan

目的 明确浙江省舟山市儿童体质量发育情况与下丘脑-垂体-肾上腺轴(HPA)相关激素的关联,并分析两者对儿童抑郁的独立和交互作用。方法 2023年3月—2024年5月在舟山市妇幼保健院纳入7~14岁儿童进行研究,采用儿童抑郁症状自评量表评估儿童的抑郁症状,并采集空腹静脉血以检测HPA轴相关激素水平。采用线性回归分析儿童体质量发育情况与HPA轴相关激素水平的关联。采用logistic回归分析体质量发育情况和HPA轴与抑郁症状的关联和两者的交互作用。结果 共纳入148例儿童,其中12例(8.11%)儿童有抑郁症状。在超重或肥胖儿童中,促肾上腺皮质激素释放激素(CRH)的中位数水平为8.83 pg/ml,显著高于正常儿童的6.89 pg/ml,差异有统计学意义(β=2.30,P<0.05),但促肾上腺皮质激素(ACTH)水平(17.52 pg/ml vs.15.30 pg/ml)和皮质醇(COR)水平(185.10 nmol/L vs.145.80 nmol/L)与体质量发育情况无关。儿童超重或肥胖(OR=0.43,95%CI:0.13~1.49)和HPA轴相关激素水平(ACTH:OR=1.31,95%CI:0.27~6.46;CRH:OR=0.73,95%CI:0.15~3.59;COR:OR=1.31,95%CI:0.28~6.20)均与抑郁症状的发生风险无显著关联(均P>0.05),两者也不存在交互作用。结论 超重或肥胖是儿童HPA轴相关激素水平偏高的危险因素,然而超重或肥胖和HPA轴异常均与儿童的抑郁症状无关。

Objective To clarify the association between physical development and hypothalamic-pituitary-adrenal(HPA) axis-related hormones in children from Zhoushan,Zhejiang Province,and to analyze their independent and interactive effects on depressive symptoms.Methods From March 2023 to May 2024,children aged 7 to 14 years were recruited from Zhoushan Women and Children Hospital.The Children's Self-Rating Depression Scale was used to assess depressive symptoms,and fasting venous blood samples were collected to measure HPA axis-related hormone levels.Linear regression models wereused to evaluate the associations between overweight/obesity and HPA axis-related hormones.logistic regression modelswere used to assess the associations between overweight/obesity,HPA axis-related hormones,and depressive symptoms,as well as their interaction effects.Results A total of 148 children were included,12 of whom(8.11%) had depressive symptoms.Among overweight/obese children,the median level of corticotropin-releasing hormone(CRH) was 8.83 pg/ml,significantly higher than the 6.89 pg/ml in normal-weight children(β=2.30,P<0.05).However,adrenocorticotropic hormone(ACTH) levels(17.52 pg/ml vs.15.30 pg/ml) and cortisol(COR) levels(185.10 nmol/L vs.145.80 nmol/L) were not associated with physical development.Overweight/obesity(OR=0.43,95% CI:0.13-1.49) and HPA axis-related hormone levels(ACTH:OR=1.31,95% CI:0.27-6.46;CRH:OR=0.73,95% CI:0.15-3.59;COR:OR=1.31,95% CI:0.28-6.20) were not significantly associated with the risk of depressive symptoms(all P>0.05),nor was there any interaction between the two factors.Conclusion Overweight/obesity was a risk factor for elevated HPA axis-related hormone levels in children.However,neither overweight/obesity nor HPA axis abnormalities were associated with depressive symptoms in children.